1. Speaker Name, Degree Position, Institution Date
Session Title
Speaker Name, Degree Position, Institution Date

2. Disclosure
The Planning Committee Members disclose the following relevant financial relationships:
[Name, Degree] – Nothing to disclose or has the following relevant relationships to disclose: list relationship and company (ex. Consultant – Abbvie)
The Presenting Faculty Member(s) disclose the following relevant financial relationships: (be sure to include preceptors for PGY presenters)
No commercial support was used in the development and implementation of this activity

3. Objectives Insert approved objectives for the session
Ensure the use of ACPE Knowledge-Activity approved objective verbs:
Remembering
Understanding
Choose
Classify
Define
Describe
Label
Discuss
List
Explain
Match
Express
Name
Identify
Recall
Locate
Relate
Outline
Record
Recognize
Repeat
Report
Select
Restate
State
Review
Summarize

4. Content Presenter Guidance:
The content is appropriate for the target audience
 All stated learning objectives have been addressed in the presentation
The presentation is fair and balanced
The presentation is based on the best available, evidence-based research and prepares pharmacists to provide patient-centered collaborative care as described in the Pharmacists’ Patient Care Process (
Generic names of medications are used. Brand names should not be used unless needed for clarity or patient safety concerns. If used, all brands within the respective class are mentioned, and the generic name accompanies the brand name.
Any off-label uses are disclosed on a summary slide at the beginning of the presentation. This should include a listing of each drug or drug class, if the entire class is discussed.
Participants are provided materials that enhance understanding of content and foster application
Self-assessment or pre-test/post-test questions have been developed to reinforce the learning objectives and to assess learners. Feedback to learners is also included, ex. correct answers with rationale
References are provided either on the respective slides or in a compilation slide at the end of the presentation.

5. Active Learning
Be sure to include active learning, for example patient cases, a pre/post quiz, and/or audience response questions are embedded throughout the content.
Recommendation:
1 active learning activity every 15 minutes to keep the audience engaged.

6. Questions?
Include a slide asking the audience for questions at the end of the presentation. This is needed for ACPE documentation purposes.